The crisis sick

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The virulence of the economic crisis keeps warning the public health experts who fear a negative impact of this on the lives and welfare of the population. The high unemployment rates in Spain, the difficulties associated with housing and in general material hardship have placed a growing group of people in vulnerable situations. Six years after the start of the recession, several studies in Spain described a worsening of self-perceived mental health and even increased suicides. Policies are key to cushion the impact of the crisis on health, which is more intense among the most vulnerable.

Spain has become a good laboratory for studying the effects of the crisis due to the intensity and duration of the recession. Unemployment in 2006 was about 6% for men and 11% for women, now reaches 26%. In 2012 there were three million people in severe poverty, according to the Observatory of Social Reality of Caritas. That same year, the first banks were left with more than 30,000 homes for nonpayment of mortgages. As noted when this newspaper published the news, the figure is an average of 115 evictions per working day, or one every 15 minutes.

It would be wrong, however, to consider that the recession has affected everyone equally. " The hardest hit are the groups that were already poor before the crisis," explains José Saturnino Martinez, a sociology professor at the University of La Laguna (Tenerife) and expert on inequality. " Spain is among the OECD countries where the poor have become poorer and the rich have noticed unless the crisis," the expert adds. Rising social inequality has been more alarming than in other countries where the per capita GDP decline has been most pronounced. These inequalities are also reflected in health.

Early studies in Spain indicate a clear impact of the crisis on health. For example, one of the last, published in the European Journal of Public Health, described an increased prevalence of poor mental health (symptoms of anxiety and depression) among men, who went from 14.7% to 16.9%. The research, led by Xavier Bartoll the Public Health Agency of Barcelona (ASPB), using data from the latest National Health Survey (2011-2012) and compared with the previous edition, prior to the start of the recession (2006 -2007).

Most affected are men 35 to 44 years and those between 45 and 54, which belong to the class of supervisors, skilled or semi-skilled, those with no college education and acting as main breadwinners of the household (the which in English is called breadwinners, or breadwinners). The study links increased mental ill health in these groups with a greater impact of unemployment. "On one hand, affected by the loss of income," says Bartoll. Then there is also a psychological factor derived from " the loss of status and role of main breadwinner of the household."

The study found no effect of unemployment on mental health of women, which the authors associate with that "women are a psychological compensation in his familiar role as a substitute for employment." This statement, controversial, is only a hypothesis that the study does not develop. Furthermore, with the same data women have worse mental health. In other studies, the minor effect of unemployment on the health of women is related to materials, not psychological. Not that the family help the woman, but man is more affected by his role as the main breadwinner of the household.

Another way to measure the impact of the crisis is through people who attend a primary care center. This is what made ​​Margalida Gili, University of the Balearic Islands, and several colleagues. The authors found "substantial and significant" increase in the proportion of patients with depression (19.4%), anxiety (8.4%) or disorders related to alcohol abuse (4.6%) between 2006 and 2011. After studying the socioeconomic context of the patients, the researchers concluded that unemployment and difficulties to deal with the mortgage explain a significant part of the increased risk of mental health problems. The authors estimated that the risk of depression for a male 40 years was almost double if this was unemployed, if there was anyone else in the family in the same situation and if I had trouble paying the mortgage.

Enric Alvarez, Chief of Psychiatry, Hospital Sant Pau, Barcelona, associated increases in anxiety disorders "theory of learned helplessness," which causes people to be unable to react to a situation that causes them pain. " If you know you can be punished, whether they deserve it as if a very specific kind of related to the inhibition of behavior is not Anxiety, generate," says Alvarez. In a crisis, fear of job loss or income would be behind these disorders. Alvarez did not receive in their daily activities that the crisis is causing more mental illness. "One thing is schizophrenia or depression, which is very serious, and other behavioral disorders are " qualifies.

Without detracting from these studies, experts point out that it takes a lot of research on the same phenomenon to have sufficient scientific evidence. Moreover, health is a "multidimensional " they say, not all indicators are subject to the same trends reality. For instance, there is evidence in the literature that recessions tend to cause a decrease in mortality rates due to, among other factors, the reduced use of vehicles (less accidents), to reduce pollution levels or less consumption of snuff. " Social factors are closely related and treating them separately is simplistic," says Joan Benach, Professor of Public Health at the University Pompeu Fabra and Greds - EMCONET member.

Researchers agree on the importance of the social determinants of health. Rising poverty, unemployment, housing problems or cuts in public services impact on welfare. A recent study by Caritas notes that 70 % of users treated in Barcelona slum problems paying rent or had poor mental health, compared to 15% among the general population of the city. The study calls for the government to put in place mechanisms to enforce the right to adequate housing. " The worst epidemic to public health are social inequalities ", Benach added.

Public policies are fundamental to cushion the effect of the crisis on health, especially in the field of reconciliation of work and family life. Good institutions may even eliminate the health effects of overwork and charges at home. " The association between long working hours and family responsibilities with the worsening health of men and women depends on the family policy model that exists in the country," says Lucia Artazcoz, the Public Health Agency of Barcelona.

The researcher has used, along with other colleagues, the data employed and living with family in the 27 countries of the European Union, divided into five types according to the models of family policy: Continental (Austria, Belgium, Germany, France, Netherlands and Luxembourg), Anglo-Saxon (UK and Ireland), Eastern Europe (Czech Republic, Estonia, Hungary, Lithuania, Latvia, Poland, Romania, Bulgaria, Slovenia and Slovakia), southern Europe (Cyprus, Greece, Spain, Italy, Malta and Portugal) and Nordic countries (Denmark, Finland and Sweden). With variations, this is a widely used in the investigation of the different welfare states model.

The study suggests that in countries with better public services to outsource childcare and dependents (the Nordic and Eastern Europe) there is no relationship between family and work burdens and health. In Anglo-Saxon countries, difficulties in reconciling work and family life more worsen health of men, because the model is very oriented to that they are responsible for obtaining family income. To measure the effects on health, research using indicators of self-perceived health status and psychological wellbeing.

In continental and southern Europe, including Spain are countries, family and work loads are associated with poor health in both sexes, although more noticeable in women fashion. "We believe this is because a high percentage of women even before the crisis were housewives were forced to enter the labor market by staying unemployed husband," says Artazcoz. They are very vulnerable people " to swallow whatever" in the workplace. As if this were not enough, they find that, upon arriving home, the man assumes the responsibility of the home, so you should do them.

The study also noted a worse health status in persons living with over 65 years. "It may reflect forced to live with parents trouble keeping your own home at all", says the researcher. For men, the decline in health is linked to increased working hours resulting from the crisis.

Fear of the impact of the crisis on public health has led some authorities to study the phenomenon. The Public Health Agency of Andalusia, a public company that depends on self-government, will soon launch an observatory to collect evidence on the impact of the crisis on mortality, mental, labor, sexual and reproductive health, food security and disease chronic. The observatory will study these effects by gender, social status or origin. In addition, researchers are studying the impact of evictions with the Stop Evictions platform.

" It should be active to protect the most vulnerable policies," says Carlos Artundo, school counselor. Artundo remember that the health system should " mitigate the worst effects of the crisis on health status." Although the extent of the impact of the different waves of cuts is not yet known, increased waiting times "is a very worrying statistic " he maintains. In Catalonia, the Generalitat has also set up an observatory to study the effects of the crisis on health. The group will release a first report throughout this semester. Artazcoz maintains that governments should take into account that "health in all policies is ". For example, " the negative effect of unemployment disappears if the affected cobra subsidy," he concludes.

 Tags: crisis, SICK

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